Nurse Utilization Review Specialist
2 weeks ago
Children's Health is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that our patients receive the most appropriate and effective care.
Responsibilities:- Conduct thorough reviews of patient records to determine medical necessity and appropriateness of care.
- Collaborate with physicians and other healthcare professionals to ensure that patients receive the most effective and efficient care.
- Develop and implement strategies to reduce unnecessary hospitalizations and improve patient outcomes.
- Provide education and support to patients and families to promote healthy behaviors and self-care.
- Participate in quality improvement initiatives to enhance patient care and safety.
- 4+ years of clinical nursing experience, with a focus on utilization review or case management.
- Current RN licensure in the state of Texas.
- Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.
- Strong analytical and problem-solving skills, with the ability to work independently and as part of a team.
- Excellent communication and interpersonal skills, with the ability to work effectively with patients, families, and healthcare professionals.
- A competitive salary and benefits package.
- Opportunities for professional growth and development.
- A collaborative and supportive work environment.
- Recognition and rewards for outstanding performance.
Children's Health is a leading pediatric healthcare system in the Dallas-Fort Worth area. We are committed to providing high-quality, patient-centered care to children and families in our community.
We are an equal opportunity employer and welcome applications from diverse candidates. If you are passionate about delivering exceptional patient care and are looking for a challenging and rewarding career opportunity, please apply today
-
Registered Nurse Utilization Review Specialist
1 month ago
Dallas, Texas, United States University of Texas Southwestern Medical Center Full timeJob SummaryWe are seeking a highly skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for conducting medical certification reviews to determine the medical necessity of acute care services.Key ResponsibilitiesConduct inpatient admission reviews for Medicare and Medicaid beneficiaries, as well...
-
Dallas, Texas, United States UT Southwestern Medical Center Full timeJob SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will conduct medical certification reviews for medical necessity for acute care facilities and services, using nationally recognized, evidence-based guidelines approved by medical staff to recommend level of...
-
Utilization Review Nurse
2 days ago
Dallas, Texas, United States UT Southwestern Medical Center Full timeJob SummaryUT Southwestern Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary hospital stays.Key ResponsibilitiesConduct medical certification reviews for medical necessity...
-
Utilization Review Nurse
1 week ago
Dallas, Texas, United States Children's Health Full timeJob Title: Utilization ReviewrnAt Children's Health, our mission is to Make Life Better for Children for 110 years, and generation to come. We recognize that their health plays a crucial role in achieving this goal.Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience,...
-
Clinical Utilization Review Nurse
2 weeks ago
Dallas, Texas, United States UT Southwestern Medical Center Full timeJob SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our Utilization Review team. As a Utilization Review Registered Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of healthcare resources.Key ResponsibilitiesConduct medical...
-
Clinical Review Nurse
3 weeks ago
Dallas, Texas, United States AmTrust Financial Full timeJob SummaryWe are seeking a skilled Clinical Review Nurse to join our team at AmTrust Financial Services. As a Clinical Review Nurse, you will play a critical role in reviewing medical necessity, appropriateness, quality, and efficiency of services for Workers' Compensation claimants.Key ResponsibilitiesPerform utilization review activities prospectively,...
-
Medical Review Specialist
5 days ago
Dallas, Texas, United States Concentra Full timeJob Title: Medical Review SpecialistConcentra is seeking a Medical Review Specialist to join our team. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family...
-
Clinical Review Specialist II
4 weeks ago
Dallas, Texas, United States CorVel Corporation Full timeJob SummaryCorVel Corporation is seeking a highly skilled Clinical Review Specialist II to join our team. As a Clinical Review Specialist II, you will play a critical role in ensuring the medical necessity of in-patient admissions and out-patient treatment, while supporting the goals of our Case Management department.Key ResponsibilitiesConduct thorough...
-
Medical Review Specialist
1 week ago
Dallas, Texas, United States Concentra Career Choice Full timeJob SummaryWe are seeking a highly skilled and experienced Medical Review Specialist to join our team at Concentra Career Choice. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and...
-
Clinical Review Nurse Specialist
2 weeks ago
Dallas, Texas, United States AmTrust Financial Full timeJob Title: Clinical Review NurseAmTrust Financial Services is seeking a skilled Clinical Review Nurse to join our team. As a Clinical Review Nurse, you will play a critical role in reviewing medical necessity, appropriateness, quality, and efficiency of services for Workers' Compensation claimants.Key Responsibilities:Perform utilization review activities...
-
Medical Review Specialist
1 month ago
Dallas, Texas, United States Dane Street, LLC Full timeJob OverviewThis remote position allows for flexible scheduling and caseload management while adhering to client-required turnaround times. Reviewers are compensated on a per-case basis as independent contractors.Candidates must be a licensed Orthopedic Surgeon in Texas with experience in testimony, depositions, or counter affidavits. Access to a Texas...
-
HEDIS Review Nurse Specialist
3 weeks ago
Dallas, Texas, United States HireOps Staffing LLC Full timeHEDIS Review Nurse Job DescriptionThis is a contracted position that will involve remote work. As a Registered Nurse (RN) or Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) with an unrestricted license in the state, you will be responsible for annual patient chart inspection/audit. The audits are conducted to ensure that providers (MDs)...
-
Auto Damage Review Specialist
4 weeks ago
Dallas, Texas, United States Kemper Full timeJob Summary:Kemper is seeking a highly skilled Auto Damage Review Specialist to join our team. As a key member of our claims department, you will be responsible for reviewing incoming auto damage demands from other carriers or entities to determine if amounts claimed are reasonable and consistent with industry standards.Key Responsibilities:Examine...
-
Automotive Claims Review Specialist
1 month ago
Dallas, Texas, United States Kemper Full timePosition Overview: Desk Review Specialist at KemperKemper, a prominent specialized insurance provider, is seeking skilled professionals to contribute positively to our clients' experiences. We pride ourselves on fostering a high-performance environment that promotes both personal and professional development while ensuring a balanced work-life approach.Key...
-
Dallas, Texas, United States Elite Full timeJob SummaryWe are seeking a highly skilled Utilization Review Nurse to join our team at Elite. As a key member of our clinical review team, you will play a critical role in ensuring the medical necessity of treatment requests submitted by providers, requestors, claimants, or carriers.Key ResponsibilitiesMedical Necessity Review: Conduct thorough evaluations...
-
Auto Damage Review Specialist
2 days ago
Dallas, Texas, United States Kemper Full timeJob Summary:Kemper is seeking a skilled Auto Damage Review Specialist to join our team. As a key member of our claims team, you will be responsible for reviewing incoming auto damage demands from other carriers or entities to determine if amounts claimed are reasonable and consistent with industry standards.Key Responsibilities:Examine third-party vehicle...
-
Neurologist Medical Review Specialist
2 weeks ago
Dallas, Texas, United States Concentra Career Choice Full timeJob SummaryWe are seeking a Board Certified Neurologist to join our medical review team as a Telehealth Medical Review Physician. This is a flexible, telecommute role that offers the ability to customize your schedule and caseload within a Monday - Friday work week and within business hours.ResponsibilitiesReviews medical files and provides recommendations...
-
Contract Review Specialist
2 days ago
Dallas, Texas, United States Cleaver-Brooks Sales and Service, Inc. Full timeJob SummaryCleaver-Brooks Sales and Service, Inc. is seeking a highly skilled Contract Review Specialist to join our team. As a key member of our organization, you will be responsible for reviewing and analyzing various contracts and purchase orders to identify potential risks and ensure compliance with company policies.Key ResponsibilitiesContract Review...
-
Neurologist Medical Review Specialist
2 weeks ago
Dallas, Texas, United States Concentra Full timeOverviewWe are seeking a skilled and experienced Board Certified Neurologist to join our medical review team as an independent contractor. As a Telehealth Physician Advisor, you will play a crucial role in reviewing health claims and providing medical interpretation and decisions about the appropriateness of services provided by other healthcare...
-
Physician Reviewer
1 week ago
Dallas, Texas, United States Dane Street, LLC Full timeJob OpportunityWe are seeking a skilled Physician Reviewer to join our team at Dane Street, LLC.About the RoleThe successful candidate will utilize their clinical expertise to review insurance appeals, prospective and retrospective claims, and provide an interpretation of the medical necessity of services provided by other healthcare professionals.Key...